Quotation Estimate Orthodontist in Uganda Kampala –Free Word Template Download with AI

Quotation Estimate No.: KSO/QE/2025/00847
Date Issued: 12 June 2025
Valid Until: 12 July 2025 (30 days) Prepared For:
Mr. David Okello
Plot 7, Ntinda, Kampala, Uganda
Tel: +256 701 234 567
Email: [email protected] 1. Introduction and Scope of Services

This Quotation Estimate is issued by Kampala Smile Orthodontic Centre, a fully licensed and accredited dental practice operating in Uganda Kampala, to provide a comprehensive and transparent breakdown of costs associated with the planned Orthodontist treatment for the above-named patient. Our Orthodontist, Dr. Grace Namutebi (MDS, Orthodontics – Makerere University College of Health Sciences), has conducted a full clinical assessment and radiographic examination of the patient's dental and skeletal structures. Based on these findings, the following treatment plan and associated costs are presented in this Quotation Estimate for the patient's review and approval.

All services described herein are delivered in accordance with the standards set by the Uganda Dental Association and the Health Professions Council of Uganda. The Orthodontist team at our Uganda Kampala facility is committed to delivering world-class orthodontic care using internationally recognised materials and techniques.

2. Itemised Quotation Estimate – Treatment Costs

No.	Description of Orthodontist Service	Quantity	Unit Price (UGX)	Total Price (UGX)
1	Initial Consultation, Clinical Examination & Digital Intraoral Photography	1 session	150,000	150,000
2	Full-Panoramic Radiograph (OPG) & Cephalometric X-Ray Analysis	1 set	250,000	250,000
3	Digital Impression & 3D Treatment Planning (Invisalign-compatible software)	1 set	350,000	350,000
4	Orthodontist Bonding of Metal Braces (Upper & Lower Arch – 28 brackets, bands, wires, ligatures)	1 set	2,800,000	2,800,000
5	Monthly Orthodontist Adjustment & Wire Change Sessions (12-month treatment period)	12 sessions	120,000	1,440,000
6	Removal of Braces, Polishing & Final Arch Form Adjustment	1 session	300,000	300,000
7	Custom-Fabricated Retainers (Upper & Lower – Essix type, 2 sets each)	4 retainers	180,000	720,000
8	Post-Orthodontic Follow-Up Reviews (3 months, 6 months, 12 months)	3 sessions	80,000	240,000
9	Emergency Orthodontist Appointment (broken bracket, wire irritation – included in plan)	Up to 2 visits	100,000	200,000
10	Professional Dental Cleaning & Fluoride Application (pre-treatment)	1 session	200,000	200,000
SUBTOTAL (UGX)				6,650,000
VAT @ 18% (Uganda Revenue Authority)				1,197,000
GRAND TOTAL (UGX)				7,847,000

Note: All prices in this Quotation Estimate are quoted in Ugandan Shillings (UGX) and are inclusive of all materials, laboratory fees, and the Orthodontist's professional time. Prices are subject to revision should the treatment plan require modification following the initial bonding session. 3. Payment Terms and Schedule

Milestone	Amount (UGX)	Due Date
Deposit (upon acceptance of this Quotation Estimate)	2,354,100 (30%)	Within 5 working days of acceptance
Second instalment (at 6-month adjustment visit)	2,746,450 (35%)	December 2025
Final balance (at brace removal & retainer fitting)	2,746,450 (35%)	June 2026

Payment may be made via bank transfer to Kampala Smile Orthodontic Centre (Bank of Uganda, Account No. 0123-456789-001), mobile money (MTN/Airtel), or in-person at our Uganda Kampala reception. A receipt will be issued for every payment received.

4. Terms and Conditions

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Beyond this period, prices may be adjusted to reflect changes in material costs or exchange rates applicable in Uganda Kampala.
The total treatment duration is estimated at twelve (12) months, subject to the clinical progress assessed by the treating Orthodontist at each monthly review. Extension beyond this period may incur additional adjustment fees.
The patient is responsible for maintaining excellent oral hygiene throughout the Orthodontist treatment. Failure to do so may result in decalcification, gingival inflammation, or treatment delays, for which no refund will be issued.
Any additional procedures not listed in this Quotation Estimate (e.g., extraction of impacted teeth, periodontal therapy, or restorative work) will be quoted separately at the prevailing Orthodontist fee schedule in Uganda Kampala.
In the event of appliance damage caused by the patient (e.g., biting hard objects, sports-related injury), a repair fee of UGX 150,000 per incident will apply, in addition to the standard adjustment charge.
This Quotation Estimate does not constitute a guarantee of a specific aesthetic outcome. The Orthodontist will use best clinical judgement to achieve the most favourable result within the constraints of the patient's anatomy.
All patient records, radiographs, and digital impressions remain the property of Kampala Smile Orthodontic Centre. A copy may be provided to the patient upon written request.
Disputes arising from this Quotation Estimate shall be resolved in accordance with the laws of the Republic of Uganda, with jurisdiction in the courts of Uganda Kampala.

5. Acceptance

By signing below, the patient acknowledges that they have read, understood, and accepted all terms outlined in this Quotation Estimate for Orthodontist services provided by Kampala Smile Orthodontic Centre, Uganda Kampala. The patient agrees to the payment schedule and treatment plan as described herein.

Patient / Guardian Signature
Name: _________________________
Date: _________________________ Orthodontist / Authorised Representative
Name: Dr. Grace Namutebi, MDS
Date: _________________________
Stamp: ⬇️ Download as DOCX Edit online as DOCX

Create your own Word template with our GoGPT AI prompt:

GoGPT